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Poll: Perry Leads

The new University of Texas/Texas Tribune Poll debuted this week with a survey that puts Kay Bailey Hutchison 12 points behind Rick Perry in the race for Texas governor, that says the Democrats are mostly unknown and trailing that perennial frontrunner, Undecided, and that finds the Maybe Race for U.S. Senate dominated by three candidates who are all, in turn, losing to Undecided.

The new University of Texas/Texas Tribune Poll debuted this week with a survey that puts Kay Bailey Hutchison 12 points behind Rick Perry in the race for Texas governor, that says the Democrats are mostly unknown and trailing that perennial frontrunner, Undecided, and that finds the Maybe Race for U.S. Senate dominated by three candidates who are all, in turn, losing to Undecided.

Both of the GOP candidates out-poll the Democrats, but Hutchison does better in those potential November 2010 matchups than Perry does. The governor only ties a generic, unnamed Democrat, while she wins that pairing by 11 percentage points.

Republican Debra Medina came in at seven points, enough to be a spoiler if the race between the top candidates tightens up. It's not clear whether her support comes from Perry or Hutchison, but of the two, Perry's political stands have been closer to Medina's than Hutchison's have.

Voters just don't know the Democrats at this point, with the exception of Kinky Friedman, the writer and entertainer who was on the ticket in 2006 as an independent. He got 19 points. Establishment candidate Tom Schieffer got 10 points. Undecided got 55 percent and six percent said they'd prefer "somebody else." Ronnie Earle, the former Travis County district attorney; Mark Thompson, who has pulled out of the race, and northeast Texas farmer Hank Gilbert, who ran for agriculture commissioner in 2006, all landed in the single digits.

In a hypothetical special election race for U.S. Senate — for the seat Hutchison now holds — Lt. Gov. David Dewhurst and Houston Mayor Bill White pulled 13 percent, followed closely by former Comptroller John Sharp, with 10 percent. The three are in a virtual tie, all within the poll's margin of error. Undecided got 56 percent, so that race, like the one for the Democratic gubernatorial nomination, is wide open. Other candidates — State Sen. Florence Shapiro, Railroad Commissioners Michael Williams and Elizabeth Ames Jones, and former Texas Secretary of State Roger Williams — were all under four percent.

Texas voters aren't well pleased with their elected leaders, particularly with the U.S. Congress: 71 percent said they "somewhat" or "strongly" disapprove of the job Congress is doing, and only 14 percent registered approval. A measly 2 percent approve strongly of the job Congress is doing. That's a pretty good clue as to why Perry keeps calling Hutchison a Washington politician.

The Internet survey of 800 registered voters was conducted October 20-27 and has a margin of error of +/- 3.46 percent. The GOP primary questions have a +/- 5.19 percent margin of error; the Democratic primary questions have a margin of error of 6.01 percent.

A Rasmussen poll in September put the spread in the governor's race at just two points, but most other surveys have shown Perry more comfortably in the lead. That same pollster had it at ten pints in July, and the University of Texas pollsters who did the UT/Texas Tribune poll had it at 12 points in June.

Neither candidate has launched a full-scale media campaign of the sort that moves the numbers and engages voters. That won't explode until January. And the Senate race, of course, will depend on whether Hutchison resigns early. And when.

Inside the Numbers

Texans say immigration tops their list of state concerns. Nearly half of them say illegal immigrants should be deported, as against 41 percent who think the immigrants should be allowed to keep their jobs, assimilate, and eventually be allowed to apply for legal status.

But there are large variances of opinion along ethnic and age lines, according to the inaugural University of Texas/Texas Tribune Poll. (Earlier stories on the poll can be found here and here.)

While 49 percent of Texans say the immigrants should be deported, younger people and minorities are more likely than Anglos and older people to support assimilation. Among Anglos, it's 61 percent to 30 percent in favor of deportation. African-Americans favor assimilation 50 percent to 38 percent. Latinos favor assimilation by a 69 percent to 20 percent margin.

The pollsters found a generation gap, too. Assimilation is favored by 18 to 29 year olds, 52 percent to 39 percent. The older the Texan, the stronger the preference for deportation. In the 30 to 44 age group, deporters outnumber assimilators 49 percent to 42 percent in the poll. The next group, 45- to 64-year-olds, show about that same spread, favoring deportation 49 percent to 41 percent. Over 65? Only 30 percent of that group favors assimilation, as against 63 percent in favor of deportation.

Other cross-tabs of interest:

• More Anglos — 44 percent — identify themselves as Republican than independent or Democratic. That's the number who said they'll definitely vote in the GOP primary — another 15 percent said they probably will. African-American voters say they'll definitely (55 percent) or probably (13 percent) vote in the Democratic primary. Hispanics lean to the Democrats, but they're less divided, with 27 percent on the red side of the room and 36 percent on the blue side. In that group, 26 percent say they don't know which primary they'll choose.

Both men and women in Texas are Republican, but there's a difference: 50 percent of male respondents say they'll vote in the GOP primary, and 40 percent of women say they will.

And there's a gap between city folk and everyone else. Voters in the "big four" metro areas — Houston, Dallas-Fort Worth, San Antonio, and Austin — are a little less likely to vote in the GOP primary than their country kin, but a lot more likely to vote in the Democratic primary (they're still Republican, overall). Voters in the metros are Republican by a 43 percent to 33 percent margin. Outside those areas, it's 48 percent to 23 percent.

• Republicans who describe themselves as ideologically "in the middle" favor Kay Bailey Hutchison in the governor's race, while those who describe themselves as "extremely conservative" prefer Rick Perry in that race. Perry leads Hutchison 42 percent to 30 percent, as we reported earlier this week.

• The gender gap in the GOP primary isn't what you might expect: Perry beats Hutchison with both male and female voters and actually has a better margin with women. His advantage among men in the survey is 43 percent to 34 percent; among women, it's 39 percent to 25 percent.

• The remarkably strong feelings about the work Congress is doing — 71 percent of Texans disapprove of it — get stronger as the ideology of the electorate gets more conservative. Ask voters to ID themselves as Democrats and Republicans on a seven-point scale that ranges from strong Democrat to strong Republican, and you find the people unhappy with Congress on the middle to right end of the scale. Unhappy independents total 73 percent, along with 98 percent of "lean Republicans", 87 percent of "not very strong Republicans", and 94 percent of "strong Republicans."

• Texans don't think the country is heading in the right direction, but that's not a uniform opinion. Minorities in the poll say the country is on the right track. Two-thirds of African Americans and 44 percent of Hispanics think the country is on track. Only 20 percent of blacks say the country is on the wrong track; 40 percent of Hispanics say so.

Something New

The Texas Tribune is starting a group of new weekly features that we hope will become a vigorous forum for ideas and policy and political arguments. As a non-profit, the Tribune will stay out of endorsements and house editorials and such, but we can offer a spot for the opinions and arguments of others. The plan is to give Texas Weekly readers an early look, the week before these columns run in the Trib.

We'll feature two columnists each week who get to write what they want, but only on invitation. The grand plan is to keep us away from the boring part of the op-ed business. We're also starting an argument each week, or trying to, by posing the same question to a group of smart people with a variety of viewpoints. The crackpot theory is that most political and policy arguments aren't two-sided, and that a smart argument might shed some light.

For the inaugural, start with two political plotters who started on the same side — working for the Democrats back in the 1980s and into the 1990s — and found their paths diverging. Glenn Smith remains a Democrat and also runs a new blog called Dog Canyon. Mark McKinnon, now a honcho at Austin-based Public Strategies, left the Democrats to work on George W. Bush's first presidential campaign and then stuck with the GOP.

After you've read some politics, we turned to four policy folks — two in office, two in the think tanks — with this question: What kind of health care reform would be best for Texas? The lineup: State Reps. Garnet Coleman, D-Houston, and John Zerwas, R-Houston, Arlene Wohlgemuth, a former legislator recently named executive director of the Texas Public Policy Foundation, and Anne Dunkelberg, associate director of the Center for Public Policy Priorities.


Mark McKinnon:

Are Republican candidates ignoring Hispanics?

Of course, there is no hotter political topic that Rick Perry vs. Kay Hutchison. A U.S. Senator taking on a Governor of her own party would be news anywhere. Here it's a Texas-size earthquake.

I love a good political contest and this one will be fun just to watch the collisions and hear the shoulder pads crack. But, I'm not going to handicap the race. I've had my head stuck in Washington for most of the last ten years, so I haven't been watching Texas politics very closely and am not terribly qualified to offer any particularly unique insights into this race that aren't obvious. But, like many other Bushies returning to Texas and turning their attention back home, I am concerned about the future of the GOP and, more importantly, the state. And what concerns me as a Republican is that this race may be focusing too much on the personalities of the candidates and the highly charged nature of the race rather than the long-term vision and consequences. I worry that either candidate could win the race but lose the future — too much focus on the politics of the next year, rather than the policies of the next decade.

One of the conventional-wisdom mantras we've heard for awhile in Texas is that because of the rapidly growing Hispanic demographic tide, it is only a matter of time, another political cycle or two, before most or all statewide offices are Democratic. And there's plenty of evidence to support such an assumption. After all, Barack Obama received 63 percent of the Hispanic vote in Texas.

The fact that the future of Texas politics will be Hispanic is indisputable. Hispanics will be the largest ethnic group in Texas in 2034. The question is which party will do a better job of providing a compelling vision and addressing the needs and dreams of Hispanics in Texas.

George W. Bush received 49 percent of the Hispanic vote in his re-election campaign in 1998. And one of the great advertising and political minds in this country, Lionel Sosa, who is from Texas and has worked for almost every Republican presidential candidate in the last few decades, believes the GOP should be the natural home for Hispanics.

"Hispanics are naturally conservative," says Sosa. "We are pro-family, pro-military, and highly religious, many Hispanics are Catholic and pro-life. We have a strong sense of patriotism, personal responsibility, ethics and morality."

Sosa thinks Democrats made a mistake in the 2000 and 2004 presidential elections of taking Hispanic support for granted and often classifying and thinking about them as "poor". Which created an opening for Republicans like George W. Bush to communicate a respectful message recognizing Hispanics as upwardly mobile, entrepreneurial and significant contributors to the small business community. As governor and then as president, Bush communicated pro-immigrant, pro-education policies that had substantial appeal in the Hispanic community.

Barack Obama did not make the mistake of taking Hispanic support for granted and as a result of an unprecedented program of outreach and mobilization was able to generate 67 percent of Hispanic support overall.

It's hard to imagine any Texas Republican candidate for Governor making the kind of mistakes Governor Pete Wilson made in California running a virulent anti-immigrant campaign that significantly damaged the GOP party brand among West Coast Hispanics.

Nor can we expect any Democratic gubernatorial candidates to take Hispanic voters for granted again. So, the fight will be around the margins. But the margins will be key. And it will be those margins that determine which party sets the agenda for the future of Texas.

And so I worry as I watch Republicans target their base voters with messages that might help win the primary but alienate Hispanics for the general election and into the future. I'm not sure that Perry's secession message rings well for Hispanics many of whom came to Texas to be part of the United States. Similarly, I think Hutchison's disappointing vote against Sonya Sotomayor for the Supreme Court sent the wrong message to Texas Hispanics. While I think Perry and Hutchison's record on issues important to Hispanics are generally favorable, it only takes a couple of ill-considered messages or votes to lose Hispanics votes around the margin.

And if Perry and Hutchison lose Hispanics votes around the margin, we could see a Democratic governor even sooner than the conventional wisdom suggests.

Glenn Smith:

Off with their pom-poms

When Stevie Ray Vaughn sang his bluesy version of the anti-littering slogan “Don’t Mess With Texas” in an ad during the 1986 Cotton Bowl Classic, the phrase instantly, if unofficially, displaced “Friendship” as the state motto.

Defiantly, Texas has been a mess ever since.

Don’t get me wrong. Texas folk are as friendly and hardworking as ever. It’s our slapstick rulers who get the blame. Had we hired them as football coaches instead of governors and the like, they’d still be peeling off the tar and feathers.

They haven’t been coaches, though. Many of ‘em, God help us, were cheerleaders: George W. Bush at Yale; Kay Bailey Hutchison at UT; Rick Perry at A&M. Cheerleaders and Republicans. What were we thinking?

Idea for seminars at the LBJ School of Public Affairs, the Baker Institute of Public Policy, and the Bush School of Government and Public Service: How do you fire a cheerleader?

Or, even better, how the hell did rough and tumble Texans, rugged individualists who prefer thirty-ought-sixes to pom-poms, get themselves into this fix?

I watched it all unfold. We could start by noting that the ascendency of Texas Republicans more or less overlapped the reign of the slasher-film franchise, Friday the 13th. Maybe after having our pants scared back on (it was, after all, sex that got the films’ victims into trouble), we took refuge in the un-sexiest place of all — the cheerleading squad. It must have seemed safer than Jason Vorhees’ Camp Crystal.

But it wasn’t sex that got us into trouble. At least that would have been fun. No, it was that other great motivator: money. Conservative, white, ill-advised aliens poured into Texas suburbs in the 80s. They were attracted, I guess, by the dirt-cheap auction of the savings & loan scandal’s foreclosed homes. The political moneymen saw the writing on the strip-mall walls and threw in with the Republicans.

These former southern Democratic stalwarts turned Republican enablers were relieved that they could finally quit wrestling with the legacy left them by President Lyndon Johnson. In the wake of the Civil Rights and Voting Rights acts, they’d spent two decades trying to hang on to the votes of Blacks and Hispanics while reassuring Anglo Texas that the future remained theirs. As Republicans, they could say goodbye to all that.

The consequence, sadly, is we’ve all had to say hello to the highest public school dropout rates and the highest insurance rates in the nation. We pay tolls to a Spanish company for the privilege of driving from one urban traffic jam to another, while the path to opportunity — college — is now so expensive most of our children can’t afford it.

Today we face the fright-fest of two of the cheerleaders —Perry and Hutchison — running against one another for governor. I’d say they were fighting over the Governor’s Mansion, except it burned down in Texas’ own Friday the 13th Part XIII.

Hutchison is hoping she can leave Perry holding the teabaggers. Perry is cheering for secession and chanting “watermelon, watermelon” at the federal economic stimulus while he takes the money.

Two experienced Democrats — Houston Mayor Bill White and former state Comptroller John Sharp — are running for the U.S. Senate. Former Ambassador Tom Schieffer, country boy Hank Gilbert and others are running for governor. “Others” is just the right category for Kinky Friedman, by the way. Democrats are on the cusp of taking back the state House. Where are their other statewide candidates? Like the Republicans, they are letting the cakewalk music play to see what seats are left open after Hutchison resigns, doesn’t resign, or just drops her pom-poms.

Health care reform is going to pass. The economy is recovering. The Republican brand is at an all-time low, dragged there by Sarah Palin, Glenn Beck, and, yes, Rick Perry. Conventional wisdom — that 2010 won’t be good for Democrats — sounds like excuse making from the lobbyists and courtiers who give mums to the cheerleaders and get their legislative perky-perks in return.

Against all odds, Democrats are more organized than ever. It is time Texas’ movers and shakers moved and shook and cleaned up our 20-year mess. You know who you are. And to paraphrase another horror show, we know what you’ve been doing these past summers.

Garnet Coleman:

A Texas-sized hole in the safety net

A reporter once noted that Governor Perry, when asked a question he did not want to answer, often replied, “It is what it is.” For the past nine years, that has also been the frustrating answer millions of uninsured and underinsured Texans received when they asked the governor and the state’s Republican leadership, “What about healthcare?”

It’s an answer of careless surrender and evidence of an underlying philosophy that is so hostile to reform. Brick by brick, the state’s healthcare system has been dismantled over the years. Starting with 2003’s rollback under Speaker Craddick, Medically Needy Medicaid —which prevented medical bankruptcies — was eliminated, then the rolls of the Children’s Health Insurance Program (CHIP) were slashed, and damaging privatization schemes were embarked upon. It continued this session as the Republican leadership killed a bill despite overwhelming approval in both chambers that would have allowed working parents to purchase CHIP coverage for their children.

If the "states' rights" leadership in Texas refuses to do anything for our state, then it's up to Congress to enact reform that will benefit all Americans, especially Texans. The best plan for health insurance reform is one that affordably covers most uninsured Texans, preserves the insurance of those already covered and lowers health care costs.

Texas’ current system has left six million Texans without health insurance. Those who can afford coverage fight every day against skyrocketing premiums, declining benefits, medical bankruptcies, preexisting conditions, and the constant threat of being kicked off their own insurance plan. Because of our dismal health standings, we have the most to gain from federal health insurance reform under consideration.

Lowering costs and maintaining affordability is essential to achieving successful reform. In 2008, an alarming 6.9 million Texans spent more than 20 percent of their income on health related costs. Due to skyrocketing insurance rates, workers are no longer rewarded with a pay raise — they have to settle for keeping their insurance.

Too many individuals can't get coverage because insurance companies use the excuse of preexisting conditions like mental illness or cancer to charge higher premiums, or deny them altogether. In a state where 10 percent of residents have diabetes and 28 percent have high blood pressure, the need for reform is paramount.

Allowing individuals to keep their insurance with them, even after losing or changing their jobs, is key. Our state unemployment rate is currently at 8.2 percent, which means that nearly 1 million Texans are unable to find work. Also important is removing the arbitrary limits that insurance companies place on annual and lifetime benefits, because our residents deserve better than being one illness or accident away from bankruptcy.

No Texan — not the insured, underinsured, or uninsured — should have to delay medical coverage because it is too costly. As Texans, we need to support a national plan because it is the best opportunity to reform the state's system.

Statistics tell a story, and being first in the nation for the number of uninsured says that there are leaders in Texas unwilling to provide healthcare to their constituents. Twenty-five percent of women aged 55-64 are uninsured. Many, who are often widows or divorced with no assistance, are waiting for Medicare to kick in on their 65th birthday to bring them the security of having health insurance once again. Another large number of individuals in need are mothers and fathers of kids on Medicaid and CHIP. These groups have fallen through the Texas-sized hole in the social safety net.

If left to this troubling philosophy, the problem will continue to grow and Texas will fall farther behind, to the detriment of its future well being. The best healthcare reform for Texas is one that rejects the failed reasoning of its recent leaders and actually attempts to solve the problem.

"It is what it is," is not a healthcare plan, and it's not a good excuse; it is a proud fanfare for mediocrity and the status quo. The current system has failed Texas families, Texas businesses, and the state as a whole. The people of Texas deserve a victory.

John Zerwas:

Let Texans take care of Texans

Like many across this great state and the nation, I have taken an intense interest in the so-called health system reforms coming from Washington, D.C. Perhaps unique to my perspective is the various roles I have played as a consumer, a doctor, a state policy maker and a member of the Appropriations Committee of the Texas House.

As a consumer of health care services I, like millions of Americans, am satisfied with the benefits of my health care insurance. It provides me assurance that in the event of illness or accident, I will have ready access to the highest quality of care found anywhere in the world. I do not want that compromised. Would I like to pay less? Absolutely! But the reforms being proposed in the nation’s capital have less to do with decreasing the cost of care, and more to do with creating bureaucracy, limited access, and mediocrity.

As an informed consumer, I support health savings accounts as a way to give consumers more control over the purchase of health care services as opposed to the Federal government’s plan of rationing health care. I support improving healthcare by rewarding quality and safety with the reduction of medical errors, instead of the government’s plan to make clinical decisions and second guess your doctor. You and your physician should decide what’s best for you, not a government employee.

As a doctor, I recognize that the cost of care is largely the responsibility of those who prescribe and deliver the care... physicians and hospitals. I see great potential in the adoption of cost effective therapies and interventions. Many of these efforts are already in place and have the potential to bring about less variation and waste in the system.

Any reform must include legitimate tort reform. Texas has been a leader in this regard with the passage of real tort reform in 2003. Since that time, Texas has enjoyed a dramatic influx of doctors to the state that has greatly improved access to care and quality.

Finally, if the government is to take over all our health care, new facilities would have to be developed before current hospitals and clinics are inundated. Massachusetts found this out when they passed a universal health care initiative that overwhelmed their health care providers. Expanded development of Federally Qualified Health Centers may be part of this answer, but better financial incentives for physicians to accept the individuals on typical government subsidized plans must be addressed. The 80th legislative session in Texas worked to improve this situation.

As a policy maker, I share the goal of universal coverage. But I feel the best way to achieve universal coverage is to build upon those systems which have proven most effective — market-based solutions. Needless to say, the Medicaid and Medicare system are not viewed as the best models. And though the VA system has made great strides in quality and safety, timely access to care continues to elude this model.

The role of policymakers should be to open the doors and remove barriers to competitive models of care aimed at those individuals who truly need a reformed system. Not those who have the financial means but choose not to purchase health insurance, and certainly not those who are in this nation illegally. The cooperative model should be nurtured as well as health savings accounts so that people can start making cost effective decisions about their own healthcare. Tax incentives have long proven an effective way to encourage behavior whether it be individual or at a corporate level.

There will always be those for whom the government will need to play a role. As the chair of the subcommittee on Health and Human Services of the Appropriations Committee during the 81st session, I can certainly attest to this fact. I joint-authored legislation that would have expanded the CHIP program, because there was not a reasonable market solution to this population — children born into families at 300% or less of the federal poverty level ($66,000/year for a family of four). In addition, I sponsored legislation called the Healthy Texans program intended to encourage competitive health plans for working individuals and small businesses at lower incomes.

Texas enjoys a legacy of stepping up to the plate when the needs of its citizens arise. But we have done so by encouraging the growth of business and making Texas a great state in which to raise families. The federal government should respect the sovereignty of the state in this regard. And just as all politics is local, the delivery of accessible, safe, quality healthcare is local. Let Texans Take Care of Texans!

Arlene Wohlgemuth:

Vouchers, tax breaks, HSAs, and private insurance

Congress stands on the cusp of passing health care legislation that would be tremendously harmful to Texas.

In August, the Texas Public Policy Foundation released a report by internationally renowned economist Dr. Arthur Laffer which concluded that health care reforms based on President Barack Obama’s agenda would lead to much higher health-care inflation and slower economic growth; cost every Texas resident an additional $4,265; and still leave roughly 30 million Americans uninsured. The Texas Health and Human Services Commission estimated the various health care bills pending in Congress could cost the state between $20 billion and $60 billion.

The latest House bill increases Medicaid eligibility to include everyone up to 150 percent of federal poverty level, costing the state of Texas almost $4 billion per year - almost one-tenth of total general revenue spending. It remains to be seen if and for how long the federal government would assume the added costs.

But if not the Obama plan or one similar, then what? Our research establishes that a patient-centered approach to health care reform would build on America’s world-leading quality and high patient satisfaction in a way that extends those benefits to even more people and empowers all patients to make their own medical decisions.

A great place to start is Medicaid, the program for the poor that is jointly funded by state and federal taxpayers. Consider that regardless of where the Medicaid eligibility limit is set, families just above the eligibility level suffer greatly. Because these families are not eligible for government assistance, they must obtain private insurance, which studies have shown is significantly more expensive because of government programs. Plus, their taxes will go up to pay the increased cost of government programs for families that make only slightly less than they do. It should not be surprising that many of these families living on the edge between self-sufficiency and government assistance are among the uninsured.

The solution to Medicaid could begin by providing eligible families with vouchers that they could use to purchase private insurance. The amount of the voucher would be on a sliding scale — government support would taper off as family incomes increase. Such an approach would reduce the bureaucracy needed to administer Medicaid and give recipients better access to care and a greater voice in their own health care decisions.

The second reform that should be tackled is the employer-based health insurance system — the relic of the 1940’s that has proven to be unsuitable for a much more fluid 21st century workforce. Providing the health-insurance tax deduction to individuals instead of employers would allow people to own their insurance and take it from job to job.

We should promote greater use of proven cost-saving tools such as health savings accounts (HSAs), which pair high-deductible, catastrophic insurance protection with tax-exempt savings accounts to cover routine medical expenses. When compared to traditional insurance plans, HSAs have reduced health care costs 12 to 20 percent the first year, and halved the rate of increase in health care costs in subsequent years.

Consumers should be free to shop across state lines for policies that meet their requirements rather than those arbitrarily set by their state government, which force unnecessary costs on people who need or want minimal coverage.

Texas can make changes that require no federal action by taking the initiative to adopt HSAs for state employee and retiree health plans, and by revisiting the 55 mandates on health insurance that have added to the cost to consumers.

The state should also reform its antiquated scope of practice laws that prohibit non-physician health professionals from practicing to the extent of their education and training. Eliminating such artificial restrictions would increase the supply of quality medical providers and provide more choices to the consumer.

Proposals such as these would reduce the role of third-party payers — especially the government — and empower patient choice, ownership and accessibility to quality health care. The financial relationship between the health care provider and the patient would be restored, and the free-market forces that have delivered more innovation, higher quality, and lower costs in most other sectors of our economy would be unleashed.

Anne Dunkelberg:

Affordable insurance, subsidies, and a national plan

The best health care reform for Texas will ensure affordable coverage for Texans of all incomes while improving quality and controlling costs.

As the state with the biggest share of uninsured (25 percent of Texans—6.1 million people), Texas stands to gain more from reform than any other state. Under proposals in Congress, Texas would receive billions of federal dollars every year in Medicaid and family premium assistance. Texas may net as much as ten federal dollars for every dollar in new state costs.

The best health reform must help everyone: low-income, middle-class, and well-to-do Texans, insured and uninsured. Premiums for insured Texans doubled over the last decade, and right now insurers can price Texans out of or deny coverage based on age, health status, or occupation. Reform must outlaw these practices, moving the industry to a new business model where money is made by improving care rather than cherry-picking the healthiest customers.

To insure most Texans, two big changes are needed: a guarantee of affordable insurance pricing for everyone, and a strong subsidy system for those who can’t pay without help.

All Texans must be able to buy insurance at an average-cost price, so individuals and small business can get insurance on the same terms as big employers. In 2008, the average family premium was $12,000, but Texas Department of Insurance (TDI) data show that in 2006 some small businesses in Texas paid annual premiums well exceeding $20,000 per person, and maximum rates paid were nearly six times more than average small-group premiums. Texans at every income level need to be protected from wild price variations and guaranteed access to health coverage at a standard price, especially those who won’t qualify for any income-based premium help.

Next, a strong subsidy system is essential for the large number of Texans who cannot afford coverage even at the average cost.

• About 59 percent of uninsured Texans have incomes under twice the poverty level, or under $44,000 for a family of four.

• Another 30 percent of uninsured Texans have incomes from 200 to 400 percent of poverty (up to $88,000 for a family of four), the proposed upper income in reform bills for premium help.

The market simply cannot provide decent coverage at an affordable price for these families.

Half of Texas households today earn less than $59,000 a year. Affordable health care would leave these families with more money to buy a home or help send their children to college, strengthening our middle class. But even then families would still be making a major contribution to paying for health care. House and Senate bills now have working families spending up to 12 percent of income on premiums, and after out-of-pocket costs are added, families may be spending up to 25 percent of their income on health care.

A public subsidy is a bedrock component of any reform system; even in wealthy Massachusetts two-thirds of newly-covered residents under the state system are Medicaid or premium assistance beneficiaries. If reform bill price tags are trimmed back any more, families will have to pay an even higher share of income. The smaller the subsidies for coverage, the greater the number who will remain uninsured.

We must have national reform. Texas is unwilling to address the problem. For example, in spite of all the talk of the market providing coverage, under current law, the Texas Department of Insurance has very little power to regulate health insurance rates and isn’t even charged with helping health insurance consumers. As another example, the Texas enrollment system for Medicaid and CHIP has been in crisis for several years and is constantly in the news and in court because it keeps qualified Texans—mostly children—waiting months to get signed up for care.

The bills moving in Congress are not perfect, but they will cover most of our uninsured, increase security and stability of coverage for those now insured, and help us get health care costs under control. Our representatives in Washington need to pass meaningful health reform this year to help Texas families and to ensure Texas a more prosperous future.

Political People and Their Moves

Al Armendariz of Dallas will be the new regional head of the Environmental Protection Agency. Armendariz, a professor of environmental and civil engineering, will head the Dallas-based region that includes Texas, Louisiana, Arkansas, Oklahoma, and New Mexico.

Former Rep. Arlene Wohlgemuth is the new executive director of the Texas Public Policy Foundation. That's a new position.

Paul Workman, a Republican challenging Rep. Valinda Bolton, D-Austin, picked up the endorsements of Bill Welch and Alex Castano — fellow Republicans who fell short in previous contests in HD-47.

Add Michael Soto to the ballot; the Democrat says he'll run for the State Board of Education seat now held by Rick Agosto of San Antonio. Agosto isn't seeking reelection next year. Soto is a professor of English at Trinity University.

Rep. Carol Kent, D-Dallas, picked up an endorsement from the Texas Medical Association's PAC.

Rep. Aaron Peña, D-Edinburg, says he will seek a fifth term in HD-40.

El Paso politics is stirring, still. Rene Diaz, a Republican, says he'll run for the HD-78 seat now held by freshman Rep. Joe Moody, D-El Paso. Earlier, Republican Jay Kleberg — a member of the famous South Texas ranching clan with ties to the King Ranch — said he'll run. And Rep. Norma Chavez, D-El Paso, is reconsidering her run for Texas Senate after seeing some polling numbers that make that hill look steeper than it looked before. She'll decide this month.

Quotes of the Week

State Board of Education member Don McLeroy, in The Texas Tribune: "The culture war over science education, the teaching of evolution, is going to be there, no matter what. Education is too important not to politicize."

Former Republican Virginia congressman Tom Davis, in The Dallas Morning News, after the GOP lost a congressional race in New York: "There's a huge revolt going on in the country against the political establishment. They couldn't care less about the party. You've got to harness that. You may not like it but you've got to harness it. It's a challenge."

State Sen. Judith Zaffirini, D-Laredo, on the workloads of food stamp workers, in the Austin American-Statesman: "That is not sustainable. I didn't know that the eligibility staff are working 8 to 8 and on Saturdays. Well, of course there's a morale issue, and of course there's a turnover issue."

Vince Leibowitz, spokesman for gubernatorial Hank Gilbert, after his candidate got 0.3 percent in the UT/Texas Tribune Poll: "I cannot believe I waited up until 4:40 in the morning for this poll. It is a complete and total joke."

Houston businessman Farouk Shami, telling the Austin American-Statesman he'll run for governor as a Democrat and plans to spend $10 million of his own money: "I am in. I am 100 percent sure I will be the next governor of Texas."


Texas Weekly: Volume 26, Issue 42, 9 November 2009. Ross Ramsey, Editor. Copyright 2009 by Printing Production Systems, Inc. All Rights Reserved. Reproduction in whole or in part without written permission from the publisher is prohibited. One-year online subscription: $250. For information about your subscription, call (512) 302-5703 or email biz@texasweekly.com. For news, email ramsey@texasweekly.com, or call (512) 288-6598.

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